Incident ischemic heart disease and recent occupational exposure to particulate matter in an aluminum cohort

Fine particulate matter (PM2.5) in air pollution, primarily from combustion sources, is recognized as an important risk factor for cardiovascular events but studies of workplace PM2.5

exposure are rare. We conducted a prospective study of exposure to PM2.5 and incidence of ischemic heart disease (IHD) in a cohort of 11,966 US aluminum workers. Incident IHD was identified

from medical claims data from 1998 to 2008. Quantitative metrics were developed for recent exposure (within the last year) and cumulative exposure; however, we emphasize recent exposure in

the absence of interpretable work histories before follow-up. IHD was modestly associated with recent PM2.5 overall. In analysis restricted to recent exposures estimated with the highest

confidence, the hazard ratio (HR) increased to 1.78 (95% CI: 1.02, 3.11) in the second quartile and remained elevated. When the analysis was stratified by work process, the HR rose

monotonically to 1.5 in both smelter and fabrication facilities, though exposure was almost an order of magnitude higher in smelters. The differential exposure–response may be due to

differences in exposure composition or healthy worker survivor effect. These results are consistent with the air pollution and cigarette smoke literature; recent exposure to PM2.5 in the

workplace appears to increase the risk of IHD incidence.

This work was supported by National Institutes of Health, Institute of Aging (R01 AG026291-01) and Center for Disease Control and Prevention, National Institute of Occupational Safety and

Health (R01OH009939-01) and by Alcoa.

NIA Data Sharing: As an alternative to providing a de-identified data set to the public domain, we allow access for the purpose of re-analyses or appropriate “follow-on” analyses by any

qualified investigator willing to sign a contractual covenant with the host Institution limiting use of data to a specific agreed upon purpose and observing the same restrictions as are

limited in our contract with Alcoa, such as 60-day manuscript review for compliance purposes.

Environmental Health Science, School of Public Health, University of California, Berkeley, California, USA

Sadie Costello, Daniel M Brown, Elizabeth M Noth, S Katharine Hammond & Ellen A Eisen

Occupational and Environmental Medicine, School of Medicine, Yale University, New Haven, Connecticut, USA

Department of Internal Medicine, Stanford University, Stanford, California, USA

Drs Costello, Brown, Noth and Eisen do not have any conflicts of interest to declare. Ms Cantley and Ms Tessier-Sherman receive salary support from Alcoa, Inc through contracts with Yale

University. Dr Cullen receives salary support from Alcoa, Inc through contracts with Stanford University. Dr Hammond receives compensation as a member of the scientific advisory board for

Alcoa, Inc and has also consulted on exposure assessment and received compensation.

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